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Sagar Salunke, 32, (Name Changed, Rank not addressed for confidentiality purpose) had served in the Armed forces. After his service, he experienced Post Traumatic Stress Disorder (PTSD) especially of his time of deployment in valley during Counter Insurgency Operations. The disorder to say the least was not only overwhelming for Mr Sagar Salunke but to his immediate family also. The gripping nature of the disorder had made Mr Salunke’s behaviour erratic and considerably reduced his productivity thus effecting his day-to-day work consequently, creating a spiral loop of stress- reduced work efficiency- low mood and feeling to not able to contribute effectively. To effectively deal with his PTSD, he underwent Eye Movement Desensitization and Reprocessing (EMDR) therapy, @therapywithsapna. EMDR is when bad memories are not processed properly by our brain, they can keep causing strong negative feelings, panic attacks, fear, anger, guilt and many other emotions, whenever the person faces triggers, EMDR prepares a person to handle similar situations better in the future.
EMDR is a therapy approach which is found to be effective to treat post-traumatic stress disorder (PTSD) and other trauma-related disorders. The therapy utilises eye movement or other forms of bilateral stimulation to process traumatic memories. Thereafter, Reprocessing aims to reprocess traumatic memories, reducing their distressing effects and promotes healing.
The first meeting especially in therapy is about breaking the ice with the client and making him comfortable and as the therapist this is critical juncture to build Clint-therapist repo for time to come. Generally, after any trauma the hard part for any client is to re-live the trauma due to the pain associated with it, however the even harder part is to talk about it and share it with anyone as the fear of being judged is too crushing.
During the course of therapy Mr Salunke was skilled with necessary tools to handle his overwhelming situations like when anxiety kicks in, these skills are taught to the client so that they can handle and process any unexpected situation themselves in between sessions, Mr Sagar identified several upsetting events from his time in service that bothered him. These were the focus areas of the therapy sessions.
As part of case study, I will take you through the seventh session with Mr Salunke. The incident in under discussion involves Mr Salunke deployment in the Kashmir valley, where one of the operations had not progressed as planned and the client and his team bought numerous casualties. When he first talked about it, he rated his distress level as a 10 (the highest possible). During this event, Mr Sagar and another involved in operation had tried to save two soldiers severely injured in a suicide attack. The undermentioned paragraphs give a brief insight of the session, where ‘T’ stands for therapist and ‘S’ is for Mr Salunke
T | As you think about Operation, what picture comes to mind that feels like the worst part? |
Mr. S | The doctor at the hospital was saying, “He is gone.” I started crying. My fellow medic, let’s call him Ravi, held my arm and said, “Come on, we need to go.”… It was one of the worst day I ever had. |
T | What negative thought do you have about yourself now when you think about it? |
Mr. S | That I couldn’t decide what to do. With respect, what are we even doing here? That mission was a mess, We were in charge, and we took too much time. |
T | I think I heard you say, “I let the soldiers down.” What negative belief do you have about yourself as you remember it now? |
Mr. S | I failed. |
T | So, if you could choose a different belief about yourself, instead of “I failed,” would it be, “I did the best I could”? |
Mr. S | No, I didn’t – I failed them. I’m sorry, I really want to help you, but I failed them. I failed them |
Sagar was finding it hard to even say a positive belief, but finally agreed that he would like to believe, “I did the best I could.” He rated how true this felt as a 1 He said the feeling he had was “pain” and the memory still felt like a 10 in terms of distress. “I feel I deserve to feel this.” He said he felt this negative feeling in his “heart.” | |
Mr. Sagar was then asked to think about the event, the negative thought “I failed,” and where he felt it in his body. He had to keep these in mind while following My hand moving left and right with his eyes, for about 30 seconds. After this set of eye movements, the client was asked him to take a deep breath and let go of everything, and then asked what he noticed now. | |
Mr. S | I feel confused. |
T | Just notice that feeling. (requested the Eye Movement) |
(Eye movements and silence) | |
T | Take a deep breath. Let it all go. What do you feel now? (This process of eye movements and asking what Sagar noticed was repeated several times) |
Mr. S | It must have been a big bomb, because the soldiers were inside a vehicle was on its side. |
T | *************** |
Mr S | I wanted to help them so much, I didn’t even care about the other threats looming around, yet.… I walked right towards them. I wanted to get the soldier out of the vehicle. Ravi was already helping his patient while I was still trying to figure out how to rescue the other soldier.… |
T | *************** |
Mr S | …It’s our duty to save lives. So, you have to do your duty, and when you don’t, people die. I can’t think of a bigger responsibility in the armed forces … |
T | *************** |
Mr S | It’s bad. It’s bad that we couldn’t save those soldiers.… It feels pointless. Every time you go out there, it’s not up to you. We did bring many people back from the brink of death. |
T | who also understood the military, picked up on something Sagar was saying that matched his training. We are not judged by how many we save, but by whether we do our best. |
Mr S | I was doing my best on that operation. (In the next few sets, Sagar remembered times when his ability to help was limited by decisions from his seniors.) “It wasn’t my decision…maybe I don’t need to hold onto this.” Several more sets focused on the idea of responsibility and decisions. |
T | What would Ravi say to you about that day? |
Mr S | …His guy was gone, man. I knew that. |
T | *************** |
Mr S | …That night on the ground… we did what we had to do, we acted like professionals. Those guys were in really bad shape. |
T | ************ |
The brief session helped the client to reconnect the dots and understand this feelings, capability, abilities and responsibility. The Client could elevate himself from a sense of failure to understanding his role and how he acted under the circumstances thus giving a sense of pride. | |
| .… I really didn’t let those guys down. I’m not God. I wish I could have saved them, but they were so badly hurt.… War is so terrible. It’s OK. I was there. It’s a mix of feelings.
|
| …I see that I can carry this memory with a sense of respect. I can carry it for those soldiers… |
This session shows how EMDR helped reduce Mr Sagar’s distress and change his thoughts. EMDR helps connect upsetting memories with more helpful and realistic information. During the therapy, Mr Sagar remembered details about the event, understood the severity of the soldiers’ injuries, and recognized his own bravery and efforts to help. He also remembered positive things about his fellow medic, Ravi, and other times in his service when he had helped save lives.
Mr Salunke also felt that the session had changed him, like he was seeing things with “different eyes.” The therapy helped with a belief he had carried since childhood, about being responsible for others’ well-being. By the end of the session, the client understood that the soldiers’ deaths were not his fault and he could let go of that heavy feeling. He said, “I feel lighter.” His feelings about what happened also changed. Instead of shame and guilt, he felt he could “carry the memory with pride.” This case shows how EMDR can help process traumatic memories, leading to less distress and healthier ways of thinking and feeling.
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